The Role of Thalidomide in the Treatment of Rheumatic Disease

摘要

Thalidomide was first introduced in 1956 as a sedative hypnotic in Europe and Asia but was soon withdrawn from the market because of its association with severe birth defects. It has experienced a resurgence of interest in recent years as a treatment for inflammatory conditions. Since Jacob Sheskin's linkage of thalidomide with improvement of refractory inflammatory dermatoses, such as erythema nodosum leprosum in the 1960's, more recent work has centered on thalidomide's use in inflammatory rheumatologic conditions. There are varying levels of evidence supporting thalidomide's efficacy in Behcet's disease, refractory oral-genital ulcera-tions, cutaneous lupus erythematosus, RA, and sarcoidosis, although dosing, clinical response, and frequency of toxicity are variable. Thalidomide seems to have anti-inflammatory, immunomodulatory, and anti-angi-ogenic properties. It is not clear which of these mechanisms are chiefly responsible for the drug's clinical efficacy.